Bone Grafting is a standard reconstructive procedure. With better understanding of the reconstruction process in the body many alternate options are available today. This talk by Dr Vaibhav Bagaria details about the various alternatives.

1. • Talk on Bone grafting options
• Learn about various alternatives
• Tips and Tricks from Dr Vaibhav
Bagaria - Director, Orthopedics,
Sir HN Reliance Foundation
Hospital, Mumbai, India
Session on Instrument & Implants: ORTHOTV Date: 13-09-2020

2. “The Craft of the Graft: the
Gold & the Other Kids”
Dr VAIBHAV BAGARIA
Bone Graft & substitutes: Basics

3. As is our Biology so is our Orthopedics!
With a Little help from biomechanics

4. The Gold!

5. The other Kids!
• More than 300 grafts available in US
• How many have them evidence?

6. The other Kids!
• Bone Marrow Aspirate
• Bone Morphogenic Protein
• Allografts
• Syntehtics
• Others: Collagen/ peptides/ DBM

7. Bone Healing
Osteogenic
Osteoinductive Osteoconductive

8. Autograft
• Illiac Crest: Accesible & Available
• 2 cm from ASIS
• LCNF
• Periosteal stripping

9. Autograft Harvest
• Raise the Pelvis 30 degree
• 5 cm Incision - 2cm posterior to ASIS
• Less Periosteal Stripping
• Sharp: multiple osteotomes
• Meticulous Closure: no Hematoma

10. Bone Marrow Aspiration
• A 1000 U per ml of saline.
• Recommended saline on table: 50 - 100 ml
• Rinse all the components to be in contact
with marrowB

11. Aspiration Site

12. Direction!

13. Aspiration Video 1

14. Ensuring Best Yield
• Freshly heparinised syringe
• Rule of 5, 15 and 30
• 5 ml in first go, turn around 90 another 5 ml, turn another 5 :
take total of 15; Withdraw the needle - reinsert through the
same incision and similarly with draw another 15. After 30 ml
from one side - > Next incision for another 30 ml.
• Draw at an optimal syringe pressure of < 5 ml to prevent
dilution and cell trauma
• 4 - 6 X Baseline; 60 ml to 10 ml

15. Ensuring High Yield

16. Bone Morphogenic Protein (
BMP)
• Wonder Growth factor: Part of TGF 2 Beta Superfamily
• Discovered by Michael Urist
• Affects almost all the body function
• May be called as ‘ Body Morphogenic Protein’

17. Infuse

19. Allograft

21. Allograft

22. Synthetics

23. ChronOS

24. Allogran & Allogran R

25. G Bone: HA

26. Stimulan

27. Zimmer Copios: HA TCP

28. Tripore

29. Take Home!
• Gold Holds the Forte!
• Technology and more importantly our understanding is
improving
• Regenerative process is a team work rather it is an
orchestra
• Instruments and Players are equally important!

30. Can we beat the returns gold
offer?

31. Surgeon

32. Scaffold
(Allograft)
Groth Factor
(BMP 2)
Cells
(Bone Marrow)
OC
OI
OG

33. Sir HN Reliance Foundation Hospi
Est 1925
The Ikigai of
Life!